#apbn

Clinical Hallmarks

Multiple Systems Atrophy (MSA) involves the clinical triad of:

Autonomic dysfunction

Extrapyramidal disease

Cerebellar dysfunction

Inspiratory stridor is a common, important clinical manifestation in MSA.

Key features are orthostatic hypotension, urinary retention/incontinence, erectile dysfunction, anhidrosis, and other features.

Note that there is no MSA-A, since prominent autonomic dysfunction is always required.

Akinesia, rigidity, and postural instability most often without tremor; it resembles PD more-so than PSP.

We use MSA-P (formerly striatonigral degeneration, SDN), if parkinsonian symptoms predominate.

Ataxia and possible cerebellar speech.

We use MSA-C (formerly, olivopontocerbellar atrophy, OPCA), if cerebellar symptoms predominate.

Pathological Hallmarks

"Hot cross buns sign" is a vommon radiographic finding in MSA.

Oligodendrocytes comprise glial cytoplasmic inclusions (GCI)

We show the pons in cross-section with a hot cross bun on top.

The white strips represent degenerated pontine white matter pathways within the pons (for more on these tracts, see our tutorial on the cortico-ponto-cerebello-thalamo-cortical pathway).

These are flame-shaped inclusions of alpha-synuclein.

OCULOMOTOR PALSY Remember: "DOWN and OUT" with a dilated pupil.

OVERVIEW OF CAUSES: MEDICAL vs SURGICAL CAUSES CN 3 lesions are generally divided into medical or surgical (compressive) causes: classically, medical third nerve lesions spare the pupil.

DIFFERENTIAL DIAGNOSIS

MEDICAL CAUSES

Isolated third nerve lesions may occur with:

Branch occlusion of the posterior cerebral artery. Most often these occur with contralateral weakness (fascicular third nerve) or with ataxia (Claude’s syndrome) or choreoathetosis (Benedict’s syndrome) from thalamoperforate branch occlusion of the P1 segment of the posterior cerebral artery.

Rarely, an ascending interpeduncular branch occlusion from the top of the basilar artery.

Myasthenia gravis frequently affects the third nerve with pupillary sparing and increased ptosis with fatigue.

Rarely, demyelinating disease affects the third nerve.

Symmetrical ptosis and oculomotor weakness is characteristic of:

Mitochondrial disease (Kearns–Sayre syndrome, progressive external ophthalmoplegia)

Congenital myopathy (centronuclear or myotubular myopathy)

Oculopharyngeal dystrophy.

Surgical (compressive) third nerve is seen with:

Aneurysms as follows:

Posterior communicating artery

Internal carotid artery

Superior cerebellar artery

Top of the basilar (often in conjunction with the fourth nerve)

Tumors:

Parasellar neoplasms

Medial sphenoid wing meningiomas

HARIANSOLORAYA.COM, JAKARTA || Program penyaluran 1.098 ekor sapi kurban Presiden Prabowo Subianto pada Hari Raya Idul Adha 1447 Hijriah menjadi sorotan nasional setelah diketahui menggunakan Anggaran Pendapatan dan Belanja Negara (APBN) melalui skema Bantuan Presiden (Banpres). Di tengah munculnya kritik dan pertanyaan publik terkait penggunaan uang negara untuk pengadaan hewan kurban, DPR RI…

HARIANSOLORAYA.COM, JAKARTA || Program penyaluran 1.098 ekor sapi kurban Presiden Prabowo Subianto pada Hari Raya Idul Adha 1447 Hijriah menjadi sorotan nasional setelah diketahui menggunakan Anggaran Pendapatan dan Belanja Negara (APBN) melalui skema Bantuan Presiden (Banpres). Di tengah munculnya kritik dan pertanyaan publik terkait penggunaan uang negara untuk pengadaan hewan kurban, DPR RI…

KABARDAERAH.OR.ID, JAKARTA || Program bantuan hewan kurban Presiden Prabowo Subianto senilai sekitar Rp100 miliar dari Anggaran Pendapatan dan Belanja Negara (APBN) menjadi sorotan publik menjelang Hari Raya Idul Adha 1447 Hijriah. Di tengah kritik yang muncul, DPR RI justru memberikan pembelaan tegas dengan menyatakan program tersebut legal, konstitusional, dan sesuai syariat Islam. Ketua Komisi…

KABARDAERAH.OR.ID, JAKARTA || Program bantuan hewan kurban Presiden Prabowo Subianto senilai sekitar Rp100 miliar dari Anggaran Pendapatan dan Belanja Negara (APBN) menjadi sorotan publik menjelang Hari Raya Idul Adha 1447 Hijriah. Di tengah kritik yang muncul, DPR RI justru memberikan pembelaan tegas dengan menyatakan program tersebut legal, konstitusional, dan sesuai syariat Islam. Ketua Komisi…